Perceived stress and coping strategies among nursing students towards rejoining college after covid-19 pandemic

The COVID-19 pandemic has had a significant impact on nursingeducation, with many programs abruptly discontinuing clinical practice. This has raised concerns among nursing students about their clinicalskill development. Because of this, the researcher was motivated to learn how nursing students perceive stress and develop coping mechanisms for returning to nursing colleges following the COVID-19 pandemic. This study aimed to assess perceived stress and coping strategies among nursing students toward rejoining college after COVID -19 pandemic.Ananalyticalcross-sectionalstudywas conducted using proportionatestratified simple random sampling technique among 317 nursing students of bachelor level at all nursing colleges affiliated to Purbanchal University in Kathmandu Valley. Data was collected usingaself-administeredquestionnaire that included the Perceived Stress Scale (PSS) and the Brief COPEScale.The majority of respondents (71.3%) reported moderate stress levels, with 28.7%reportinghighstresslevels.Half of the respondents (51.7%) had low coping levels, while the other half (48.3%) had high coping levels. There was a significant association between the level of coping and mother’s occupation (p = 0.003). The Pearson correlation between perceived stress and coping strategies was moderately positive (r = 0.256, p = 0.001).Nursing college administration and instructors can play a role in reducing student stress and promoting coping strategies by maintaining a safecollege environment for students rejoining college after the COVID-19 pandemic.

General guidance is provided below.
Consult the submission guidelines for detailed instructions.Make sure that all information entered here is included in the Methods section of the manuscript.Firstly, permission letter was taken from all 11 colleges for data collection and ethical approval was taken from Institutional Review Board (IRB) of Nepal Health Research Council(NHRC) for ethical clearance.Approval Number for this study is 657/2021P and Reference no 1302.Written informed consent was taken from each respondent after explaining the purpose of the study.Confidentiality of the information of the respondents was maintained by not disclosing the information and by using information for the purpose of the study.Respondents dignity was maintained by giving right to reject or discontinue from the study at any time without any penalty.Yes -all data are fully available without restriction Objective: The present study aimed to assess perceived stress and coping strategies among nursing students toward rejoining college after COVID -19 pandemic.

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Methodology: An analytical cross-sectional study was conducted using proportionate stratified simple random sampling technique among nursing students of all nursing colleges affiliated to Purbanchal University in Kathmandu Valley.Altogether, 317 nursing students of bachelor level were selected.Data was collected by using a self-administered questionnaire.Perceived stress was assessed using Perceived Stress Scale (PSS), a five-point Likert scale with ten items, and coping strategies were considered using the Brief COPE Scale, a four-point Likert scale with 28 items.

Results:
The majority of 71.3 % of the respondents' stress level was moderate, and 28.7% were high.The level of coping among half 51.7% of the respondents was low, and nearly half, 48.3%, had a high coping.There was significant association between level of coping and mother's occupation (p=0.003).The Pearson correlation between perceived stress and coping strategies was moderately positive (r = 0.256, p=0.001).

Conclusion:
The nursing college administration and instructors might contribute to lowering students' stress with effective coping strategies..Nepal also closed all schools to prevent disease at the earliest possible stage, sealed its international borders, and implemented a nationwide lockdown until June 14, 2020.
After the lockdown, colleges and schools continued education by distance education.
Youngsters started worrying about COVID-19, the duration of the pandemic, social distancing, which caused them to experience stress 4 .Many universities implemented preventive measures, including closing colleges, canceling classes, transitioning to online-based teaching/learning, examinations and postponing practical based learning.No one could predict how long such measures would continue and whether they will be able to resume their activities as before.Such disruptions can exert extra additional pressures which adversely affect students' mental health, increasing stress, anxiety, and depression 5,6 .
Considering the pandemic's magnitude and rapid spread, the increased worry and stress in the general population, students, and healthcare workers are understandable 7,8 .The disease significantly impacts mental health, causing people to experience various degrees of emotional problems 9 .College students' mental health and unhealthy behavior patterns took important place in professional and public discussions.College students often faced situations that can be risky in terms of psychiatric disorders 10 .The alarming prevalence of 80% of perceived stress among medical college students, including nursing, the use of different coping strategies, and their recommendation for the need to stress management programs 11 contribute to the importance of research in this issue.
It can be noticed that individuals' mental illness is an economic burden, especially for their families, both in terms of treatment costs and reducing productivity 12 .Low or moderate stress levels might enhance students' motivation, leading to greater effort while studying and achieving their goals.Conversely, high-stress levels can negatively influence students, leading to anxiety and depression, affecting students' health as well as academic performance 13 .
The interruption of education for nursing students has been unexpected from students.In addition, the clinical practice of nursing students in hospitals has also been discontinued.
Because much of nursing education consists of clinical practice, students may have been concerned about inadequate clinical skill development.Also, the application skills are insufficient, so the uncertainty of when, where and how to do the compensatory practicum to eliminate inadequacy could stress nursing students 14.Along with this students were scared to resume college and their practicum due to spread and emergence of new variants.
In the US 71% of students reported increased stress due to COVID-19 15 .In Spain, approximately half of the students, 47.92% experienced a moderate level of stress 16.Likewise, Turkish nursing students experienced a moderate level of stress, with a perceived stress score of 31.69 ± 6.91 14 .Saudi, nursing students experience a high-stress level 17 .Similarly, Indian nursing students showed a moderate level of stress during COVID-19, with a maximum mean perceived stress score 22.56 18 .In Nepal, 84.1% of nursing students perceived a moderate stress level 19 .
Coping mechanisms are also essential to deal with nursing students' daily stress.
Longitudinal studies have shown that stress levels in nursing students may increase or decrease during their educational training, depending on their coping behavior strategies.Besides these differences, coping strategies vary according to the individual's characteristics and the context where the stressors are found 20 .Problem-solving strategies have been identified as one of the best ways to cope with stress.Conversely, emotional-based coping strategies appear to be the least influential 21 .
Nepalese nursing students had a moderate coping strategy (63.3%), and adaptive coping strategies were highly used 19 .However, the direction of the relationship between emotional responses and coping strategies is not clear, and the connection is not always constant 22 .So, the perceived stress and the coping strategies among nursing students during a significant infectious disease such as COVID-19 needs further research to clarify.
As a nursing teacher, the researcher observed stressful concerns among many nursing Therefore the researcher is interested and aimed to find out perceived stress and coping strategies among nursing students towards rejoining college after the COVID-19 pandemic.This will provide evidence to make informed strategies to facilitate enabling environment to motivate students to rejoin physical classes and clinical postings.The study might help nursing college administration and instructors identify stress among students and formulate the protocol for coping strategies which might ultimately improve the quality of nursing education and produce productive students.The findings of the study might be used as a reference point for further research in the future.

Study Design
A descriptive, analytical study design was used to assess perceived stress and coping strategies among nursing students towards rejoining college after COVID -19 pandemic.

Study Setting and Population
This  24 was used to assess perceived stress among nursing students and Brief-COPE Scale developed by Carver (1997) 25

Ethical Considerations
Firstly, permission letter was taken from all 11 colleges for data collection and ethical approval was taken from Institutional Review Board (IRB) of Nepal Health Research Council for ethical clearance.Approval Number for this study is 657/2021P and Reference no 1302.Written informed consent was taken from each respondent after explaining the purpose of the study.
Confidentiality of the information of the respondents was maintained by not disclosing the information and by using information for the purpose of the study.Respondents dignity was maintained by giving right to reject or discontinue from the study at any time without any penalty.

Data Collection Procedure
Firstly respondents were requested to sign informed consent by explaining the purposes of study.
Data was collected through self administered questionnaire form which took about 30 minutes.
Data was collected from 21st December 2021 to 11th September 2022.At the end of the data collection, questionnaires was checked for its completeness and accuracy.

Data Analysis
The data was edited, organized, coded and entered in Statistical Package for Social Science (SPSS) version 20.Data was analyzed by using descriptive and appropriate inferential statistics that is chi-square test, Pearson correlation.

RESULTS AND DISCUSSION
The results are presented in two parts.Part I includes descriptive analysis and part II includes inferential analysis.
Part I      10 shows that there was no significant association between level of coping and respondents' family income, parents' education and father's occupation but there was significant association between level of coping and mother's occupation (p=0.003).
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for specific study types Human Subject Research (involving human participants and/or tissue) Give the name of the institutional review board or ethics committee that approved the study • Include the approval number and/or a statement indicating approval of this research • Indicate the form of consent obtained (written/oral) or the reason that consent was not obtained (e.g. the data were analyzed anonymously) • Animal Research (involving vertebrate animals, embryos or tissues) Provide the name of the Institutional Animal Care and Use Committee (IACUC) or other relevant ethics board that reviewed the study protocol, and indicate whether they approved this research or granted a formal waiver of ethical approval • Include an approval number if one was obtained • If the study involved non-human primates, add additional details about animal welfare and steps taken to ameliorate suffering • If anesthesia, euthanasia, or any kind of animal sacrifice is part of the study, include briefly which substances and/or methods were applied • Field Research Include the following details if this study involves the collection of plant, animal, or other materials from a natural setting: Field permit number • Name of the institution or relevant body that granted permission • Data Availability Authors are required to make all data underlying the findings described fully available, without restriction, and from the time of publication.PLOS allows rare exceptions to address legal and ethical concerns.See the PLOS Data Policy and FAQ for detailed information.
students and their parents regarding the completion of the academic year.The stress is both on theoretical and practical course completion.Currently, students are attending online classes, which are gradually becoming their new normal.They express not having the will to resume physical classes and clinical posting due to fear of COVID-19 infection and getting habituated to online courses over time.Due to the mandatory rule for fulfilling the practical requirement of nursing education, the students must rejoin physical classes and clinical postings sooner or later.
was used to find out the coping strategies adapted by nursing students.This instrument was divided into three parts: Part I-Questions related to socio-demographic and profession related information.Part II -Perceived Stress Scale (PSS).It is 5 point Likert scale ranging from 0-4, consisting 10 items with maximum possible score of 40.Part III-Brief-COPE Scale.It is 4 point Likert scale ranging from1-4 with 14 sub scales.Each subscale consists of 2 items where total items are 28 with maximum possible score of 112.

Corporation 1 PERCEIVED STRESS AND COPING STRATEGIES AMONG NURSING STUDENTS TOWARDS REJOINING COLLEGE AFTER COVID-19 PANDEMIC
Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation COVID-19's devastating and unpredictable global spread has resulted in remarkable global lockdowns and a massive burden on healthcare systems.The global pandemic has proven to be challenging for students in many ways.Following COVID-19, the nursing education that requires students to learn clinical skills and theory has been abruptly discontinued.Nursing students have been worried about poor clinical skill development because a large portion of nursing education involves clinical practice.Because of this, the researcher was motivated to learn how nursing students perceive stress and develop coping mechanisms for returning to nursing colleges following the COVID-19 pandemic.
Powered by Editorial Manager® and ProduXion Manager® from Aries SystemsDesignation: Lecturer, Email Id: pooja.gauro@gmail.comAffiliated Organization: Asian College for Advance Studies, Satdobato ,Lalitpur ABSTRACT Introduction: COVID-19 was declared as pandemic by the World Health Organization (WHO) on March 11, 2020.The disease is caused by the new coronavirus SARS-CoV-2, which quickly spread across the World.The virus was identified initially in Wuhan, China, in December 2019 and was defined in early January.Public Health Emergency of International Concern was announced on January 30, 2020.COVID-19's devastating and unpredictable global spread has resulted in global lockdowns and a massive burden on healthcare systems 1 .
Key Words: Coping, Nursing Students, Pandemic, : Perceived Stress 1. INTRODUCTION In Nepal the first case of COVID-19 was identified on January 23, 2020, on a Nepali student who had recently returned from Wuhan, China 2 .After no new cases were recorded in February 2020, a 19-year-old girl who had returned from France on March 17 was diagnosed with COVID-19 on March 23, 2020 study was conducted in all nursing colleges having Bachelor of Science in Nursing (BSN) bachelor level nursing students.The total study population was (N= 1476).Students studying in 2 nd and 3 rd year of PBNS and students of 2 nd, 3 rd and 4th year of BSN program in nursing colleges located at Kathmandu Valley.

TABLE 3 .1: Socio-demographic Information of the Respondents n = 317
.4%).Almost 83.2 % of the respondents were unmarried and most of them lived in 206 home (80.8%) and 73.2% belonged to nuclear family.

TABLE 3 .2: Family Related Information of the Respondents
Table2states the family related information of the respondents.Almost half (49.5%) of the respondent's monthly family income was above NRs, 50000.Approximately 27.8 % of the father's education was higher secondary whereas 28.7 % of the mother's education was secondary level.Almost half the respondent's fathers did some kind of business where as 67.2 % of the mother's occupation was house wife.

Table 3
states the professional characteristics of the respondents.More than half (56.8%) of the 220 respondents were studying Bachelor of Science in Nursing.Near about half of the them (47.3)221 studied in third year.Almost 32.2 % of them were involved in work activities.None of them were exposed in any kinds of pandemic before.More than half of the respondent received some kind of support during pandemic.

Table 4
reveals that the perceived stress score ranged from 14 to 40 with a mean of 22.95 (SD = 8.09).The perceived stress scale's absolute skew value was lower than 2 and absolute kurtosis value lower than 7.The brief coping score ranged from 28-105 with a Mean±SD of 65.55±12.45.The scores for problem focused ranged from 8 to 32 with Mean±SD of 21.69± 4.62,

TABLE 3 .5: Level of Perceived Stress of the Respondents n = 317Table 5 ,
reveals the level of perceived stress among the respondents.Majority (71.3%) of the respondents has moderate and almost one third (28.7 %) of the respondents has high stress.

Table 6 ,
reveals the level of coping among the respondents.More than half of the respondents (51.7%) have low coping and near about half (48.3%) of the respondents have high coping.

TABLE 3 .8: Association between Level of Stress and Family Related Information
Table8shows that there was no significant association between level of stress and family related information of the respondents.

TABLE 3 .9: Association between Level of Coping and Socio-demographic Information n=317
Significant Level at 0.05 Table9shows that there was no significant association between level of coping and sociodemographic variables of the respondents.

TABLE 3 .10: Association between Level of Coping and Family related Variables n=317
* Likelihood ratioTable

TABLE 3 .11: Relationship between Perceived Stress and Coping Strategies n=317
Table11depicts the pearson correlation which was calculated to find out bivariate relationship between perceived stress and coping strategies, significant relationship was found between stress and coping among respondents (r = 0.256, p=0.001).The strength of relationship was moderately positive.